Safer Futures Referral

Please use this form to provide your details (or details of the person you are referring for support)

Basic Details

Note: If the client's date of birth is not known, please leave this field blank.

Consent

All information processing will be managed in accordance with all UK and EU data protection legislation, including the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. We will only share your information when we have specific consent to do so, if there is a safeguarding concern that requires us to share your information to keep you or someone else safe or if we are instructed to do so by a court of law. Professional Referral: By selecting 'Yes' you are confirming that you have either:

  • The consent of the client to share their information and for us to make contact, in accordance with the aforementioned Data Protection Legislation

OR

  • You believe there to be a serious safeguarding concern or risk of harm posed to the individual you are referring or any other associated adult or child
Please follow this link to read our full confidentiality statement and data protection policy.

If you do not consent to the information sharing terms and conditions, we are unfortunately unable to take an online referral for you. Please contact us on 0300 777 4777.

If you are contacting us for yourself, a family member or a friend, please press the submit button at the top of the page now.

If you are making a professional referral, please continue and provide as much information as you can, to ensure you are in line with safeguarding and data sharing requirements.

Referrer Details

Extra Referral Details